He Aihua, Yang Tianli, Lu Sijia, Zou Yangyun, Wan Cheng, Chen Yulin, Zhao Jing, Liu Nenghui, Liu Donge, Li Yumei, Wang Yonggang, Xu Bin, Hao Jie, Fu Jing, Zhang Qiong, Wang Baisheng, Li Yanping
Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, People's Republic of China.
Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410008, Hunan, People's Republic of China.
J Assist Reprod Genet. 2025 Apr 30. doi: 10.1007/s10815-025-03468-8.
This study aims to establish a single-time point RNA-sequencing-based endometrial receptivity test (rsERT) to provide hourly precision of endometrial WOI for patients with recurrent implantation failure (RIF).
A two-phase study was conducted. In the first phase, a total of 70 patients with successful intrauterine pregnancy after personalized embryo transfer (pET) guided by three-time points rsERT were recruited for modified rsERT. Another 21 patients who underwent the prototype of single-time point rsERT were further included for optimization. In the second phase, another cohort of 574 patients with RIF that was recruited and assigned to the experimental group underwent pET guided by the modified rsERT (n = 261) or the control group underwent conventional ET (n = 313). The positive β-human chorionic gonadotropin (β-hCG), intrauterine pregnancy rate (IPR), implantation rate (IR), ongoing pregnancy rate, and live birth rate of the two groups were analyzed.
The modified rsERT provided an hour-based predictive result of endometrial WOI with an average accuracy of 94.51% and sensitivity and specificity of 92.73% and 96.29%, respectively. The positive β-hCG, IPR, IR, ongoing pregnancy rate, and live birth rate of the experimental group were significantly different from those in the control group. After propensity score matching (PSM) control for the confounders, positive β-hCG, IR, and early spontaneous abortion rate showed significant differences.
The modified rsERT provided hourly precision WOI prediction using a single-time point endometrial biopsy and pregnancy outcomes were significantly improved, providing an enhanced endometrial receptivity test as an alternative requiring only a single-time point sampling for patients with RIF.
本研究旨在建立一种基于单次时间点RNA测序的子宫内膜容受性检测方法（rsERT），为反复种植失败（RIF）患者提供子宫内膜着床窗口（WOI）的每小时精确信息。
进行了一项两阶段研究。在第一阶段，招募了70例在三次时间点rsERT指导下进行个性化胚胎移植（pET）后成功宫内妊娠的患者进行改良rsERT。另外纳入21例接受单次时间点rsERT原型检测的患者进行优化。在第二阶段，招募了另一组574例RIF患者，将其分配到实验组，在改良rsERT指导下进行pET（n = 261），对照组进行常规胚胎移植（ET，n = 313）。分析两组的β-人绒毛膜促性腺激素（β-hCG）阳性率、宫内妊娠率（IPR）、着床率（IR）、持续妊娠率和活产率。
改良后的rsERT提供了基于小时的子宫内膜WOI预测结果，平均准确率为94.51%，敏感性和特异性分别为92.73%和96.29%。实验组的β-hCG阳性率、IPR、IR、持续妊娠率和活产率与对照组有显著差异。在对混杂因素进行倾向评分匹配（PSM）控制后，β-hCG阳性率、IR和早期自然流产率显示出显著差异。
改良后的rsERT通过单次时间点子宫内膜活检提供了每小时精确的WOI预测，妊娠结局得到显著改善，为RIF患者提供了一种仅需单次时间点采样的增强型子宫内膜容受性检测方法。
